nutrition in children

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  • Eating is an essential part of the daily needs of the body.
  • Adequate protein during pregnancy is requried.
  • SHOULD START WITH PHYSICAL EXAMINATION . IT INCLUDES:
  • nutrition in children

    1. 2. NUTRITION IN CHILDREN
    2. 3. “ WE ARE WHAT WE EAT”
    3. 4. DEFINITIONS <ul><li>NUTRITION: </li></ul><ul><li>W.H.O: the science of food and its relationship to health. </li></ul><ul><li>It is concerned primarily with the part played by the nutrient in body growth, development and maintenance. </li></ul><ul><li>NIZEL: the science which deals with the study of nutrients and foods and their effects on the nature and function of the organism under different conditions of age, health and disease. </li></ul><ul><li>DCNA 2003: the science, how the body utilizes food to meet the requirement for development , growth, repair and maintenance. </li></ul>
    4. 5. <ul><li>DIET </li></ul><ul><li>Nizel (1989): total oral intake of a substance that provides nourishment & supply. </li></ul><ul><li>P.M Randelph(1981) : It is the total intake of substance that furnish nourishment & or calories to the body. </li></ul>
    5. 6. <ul><li>BALANCED DIET: is the one which contains varieties of foods in such quantities and proportion that are needed for energy. </li></ul><ul><li>RECOMMENDED DIETARY ALLOWANCE : nutrient amounts in excess of what 98% of the population requires to maintain health. </li></ul>
    6. 7. WHY do we need nutrition ?
    7. 8. ENERGY NEEDS OF THE BODY <ul><li>Calculated by the sum of 4 factors: </li></ul><ul><li>Basal metabolism </li></ul><ul><li>Energy for physical activity </li></ul><ul><li>Energy used for body heat </li></ul><ul><li>Specific dynamic action of food (SDA) </li></ul>
    8. 9. CALORIES AND ENERGY <ul><li>Energy made available to body in 4 basic forms: </li></ul><ul><li>CHEMICAL - for synthesis of new compounds </li></ul><ul><li>MECHANICAL - for muscle contraction </li></ul><ul><li>ELECTRICAL - for brain and nerve activity </li></ul><ul><li>THERMAL - for regulation of body temperature </li></ul>
    9. 10. Functions of the food * <ul><li>Physiological function </li></ul><ul><li>Social function </li></ul><ul><li>Psychological function </li></ul><ul><li>PHYSIOLOGICAL FUNCTION : </li></ul><ul><li>supply energy. </li></ul><ul><li>build & maintain the cells & tissues </li></ul><ul><li>regulate body process - movement of fluids </li></ul><ul><li>control acid & base balance </li></ul><ul><li>coagulation of blood </li></ul><ul><li>activation of enzyme </li></ul>
    10. 11. <ul><li>SOCIAL FUNCTIONS OF FOOD : </li></ul><ul><li>Acts as media to develop social rapport in the society. </li></ul><ul><li>Is an integral part of social phase of university living. </li></ul><ul><li>PSYCHOLOGICAL FUNCTION OF FOOD : </li></ul><ul><li>Satisfies of certain emotional needs. </li></ul><ul><li>Used to express feelings: </li></ul><ul><li>a) Token of friendship </li></ul><ul><li>b) Serving of favorite foods - expression of special </li></ul><ul><li>attention. </li></ul><ul><li>c) Withholding of wanted foods - punishment. </li></ul>
    11. 12. BASAL METABOLIC RATE <ul><li>Basal metabolic rate (BMR) – the number of calories expended by the organism per square meter of body surface per hour (kcal/m 2 /hr). </li></ul>
    12. 13. NORMAL BMR VALUES FOR DIFFERENT AGE GROUP AND SEX . Age in yrs Male kcal female kcal 5 53 51 10 49 46 15 46 40 20 41 36 30 39 36 40 38 36 50 37 34 60 35 33
    13. 14. Recommended Dietary Allowance <ul><li>RDA – nutrient amounts in excess of what 98% of the population requires to maintain health ; they are not minimum requirements or optimal intakes for all people. </li></ul><ul><li>Average daily intake energy and nutrient level intake estimates for healthy populn , through consumption of variety of foods. </li></ul><ul><li>Food & nutrition board --- Dietary reference intakes. </li></ul>
    14. 15. DCNA 2003 Values –mg
    15. 16.
    16. 18. What ? Where ? How ?
    17. 19. CLASSIFICATION OF NUTRIENTS <ul><li>CARBOHYDRATES </li></ul><ul><li>PROTEINS </li></ul><ul><li>FATS </li></ul><ul><li>VITAMINS </li></ul><ul><li>MINERALS </li></ul><ul><li>WATER </li></ul>
    18. 20. CARBOHYDRATES <ul><li>Latin (hydrated water) </li></ul><ul><li>C, H, O </li></ul><ul><li>Major source of energy- 50-60% </li></ul>CARBOHYDRATES SIMPLES SUGARS COMPLEX SUGARS Oligosaccharides Disaccharides Monosaccharides starch fibers insoluble soluble amylopectin amylose
    19. 21. <ul><li>Sources of energy : </li></ul><ul><li>Cereals </li></ul><ul><li>Bread </li></ul><ul><li>Vegetable- root tuber, seed, </li></ul><ul><li>leafy types-glucose and fructose. </li></ul><ul><li>Fruits.- fresh and dried-fructose, cellulose, hemi cellulose, dextrin, </li></ul><ul><li>pectin. </li></ul><ul><li>Sugar & corn syrup- combn of mono &disaccharide, - highest % of </li></ul><ul><li>carbohydrate on a dry weight basis. </li></ul>
    20. 23. <ul><li>FUNCTIONS: </li></ul><ul><li>Provide energy. </li></ul><ul><li>Facilitate digestion of fats. </li></ul><ul><li>Spares proteins. </li></ul><ul><li>Contribute to structural elements of body. </li></ul><ul><li>Provide palatability and sweetness to food </li></ul><ul><li>Furnish dietary fiber for normal peristalsis </li></ul>
    21. 24. ROLE IN DENTAL CARIES <ul><li>Vipeholm study. </li></ul><ul><li>Nature of sugar. </li></ul><ul><li>Time of consumption. </li></ul><ul><li>Physical from. </li></ul><ul><li>Frequency. </li></ul><ul><li>Hopewood study. </li></ul><ul><li>Turku sugar study </li></ul>
    22. 25. PROTEINS <ul><li>Nutrient “of first importance” </li></ul><ul><li>Derived – Greek word , ‘FIRST RANK’ </li></ul><ul><li>Classification: EAA and NEA </li></ul><ul><li>FUNCTIONS: </li></ul><ul><li>1. GROWTH, REPAIR AND MAINTENANCE. </li></ul><ul><li>2. Essential component of enzymes and hormones </li></ul><ul><li>3. Transport molecules </li></ul><ul><li>4. Immunoglobulin. </li></ul><ul><li>5. Source of energy </li></ul>
    23. 26. <ul><li>SOURCES: </li></ul><ul><li>In cytoplasm , cell membrane </li></ul><ul><li>Mammalian muscle - 20% </li></ul><ul><li>Blood plasma- 7% </li></ul><ul><li>Cow's milk- 35% </li></ul><ul><li>Cereals- 12% </li></ul><ul><li>Beans </li></ul><ul><li>Nuts 20% </li></ul><ul><li>Pulses </li></ul>
    24. 27. PROTEIN ENERGY MALNUTRITION <ul><li>KWASHIORKOR: </li></ul><ul><li>Adequate in calories but deficient in protein </li></ul><ul><li>Infants, preschool children – 1- 4 yrs </li></ul><ul><li>Growth retardation </li></ul><ul><li>Edema </li></ul><ul><li>Mental apathy </li></ul><ul><li>Wasting of muscles but preserved adipose tissues </li></ul><ul><li>‘Flaky-paint’ skin rash </li></ul><ul><li>Distended abdomen and enlarged liver </li></ul><ul><li>Hair-sparse and depigmented </li></ul><ul><li>Diarrhoea, hypothermia, bradycardia and hypotension </li></ul>
    25. 28. FLAKY PAINT SKIN RASH
    26. 29. <ul><li>ORAL SYMPTOMS: </li></ul><ul><ul><li>Tongue is bright & red with loss of papillae </li></ul></ul><ul><ul><li>Bilateral angular cheilosis </li></ul></ul><ul><ul><li>Fissuring of lips </li></ul></ul><ul><ul><li>Loss of circum oral pigmentation </li></ul></ul><ul><ul><li>Decreased growth of jaws </li></ul></ul>
    27. 30. <ul><li>MARASMUS: </li></ul><ul><li>Both protein and calorie deficiency </li></ul><ul><li>Occurs in children less than 1 year </li></ul><ul><li>Gross muscle and subcutaneous fat wasting. </li></ul><ul><li>ABSENCE OF EDEMA </li></ul><ul><li>Withdrawn and apathetic </li></ul><ul><li>Skinfold thickness and mid-arm circumference markedly reduced </li></ul>
    28. 31. MANAGEMENT OF PEM: <ul><li>DOMICILIARY MANAGEMENT: </li></ul><ul><ul><li>Children -mild to moderate nutrition </li></ul></ul><ul><ul><li>Best managed in homes. </li></ul></ul><ul><ul><li>Educate parents </li></ul></ul><ul><li>ADVANCE MANAGEMENT: </li></ul><ul><ul><li>100 kcal/ kg of expected wt. </li></ul></ul><ul><ul><li>Feed in small amounts. </li></ul></ul><ul><ul><li>Frequent intervals. </li></ul></ul><ul><ul><li>Associated anemia & </li></ul></ul><ul><ul><li>Superadded infection </li></ul></ul>
    29. 32. PROTEIN NUTRITION IN ORAL HEALTH AND DISEASE <ul><li>Effect of protein deficiency on the jaw and teeth: </li></ul><ul><li>consumption of too little EAA –critical period of active growth – permanent structural damage. </li></ul><ul><li>PEM- rotated teeth, crowded, retarded growth of jaw bone. </li></ul><ul><li>BAVETTA et al -protein def diet to rats </li></ul><ul><ul><li>irregular predentin layer & </li></ul></ul><ul><ul><li>interglobular spaces in poorly calcified dentinal matrix. </li></ul></ul>
    30. 33. <ul><li>Nigerian children with kwashiorkor – </li></ul><ul><ul><li>delayed eruption </li></ul></ul><ul><ul><li>hypoplasia of deciduous teeth. </li></ul></ul><ul><li>Effect of protein deficiency on dental caries: </li></ul><ul><ul><li>Animal studies- lysine and glycine- prevent caries </li></ul></ul><ul><li>EFFECT ON ORAL EPITHELIUM. </li></ul>
    31. 34. LIPIDS <ul><li>Saturated, unsaturated and essential fatty acids </li></ul><ul><li>FUNCTIONS: </li></ul><ul><li>Excellent source of energy </li></ul><ul><li>Inflammatory mediators. </li></ul><ul><li>Provide essential fatty acids </li></ul><ul><li>fat soluble vitamins. </li></ul><ul><li>Maintain body temperature </li></ul><ul><li>Cushioning mechanism against injury </li></ul><ul><li>Pleasant flavor and consistency to food </li></ul><ul><li>Sense of fullness and satisfaction </li></ul>
    32. 35. <ul><li>SOURCES: 90% of fat: </li></ul><ul><li>Salad, cooking oils, butter, margarine </li></ul><ul><li>Meat poultry, fish </li></ul><ul><li>Milk, cheese, yogurt </li></ul><ul><li>Butter, margarine, vegetable oils </li></ul>
    33. 36. CLASSIFICATION: 1. SIMPLE LIPIDS : Neutral fats Waxes 2. COMPOUND LIPDS : Phospholipids Glycolipids Lipoprotein & others 3. DERIVED LIPIDS : Fatty lipids Glycerol Sterols and others
    34. 37. FATS AND ORAL HEALTH <ul><li>Important for initiation of calcification and mineralization of teeth. </li></ul><ul><li>Dental caries: anticariogenic effect </li></ul><ul><ul><li>Coating on tooth surface. </li></ul></ul><ul><ul><li>Covering over plaque. </li></ul></ul><ul><ul><li>Interfere with growth of cariogenic bacteria. </li></ul></ul>
    35. 38. VITAMINS <ul><li>Group of organic compounds that are essential in small quantities in the diet of higher animals to perform specific cellular functions. </li></ul><ul><li>FUNCTION: </li></ul><ul><li>Acts as co-enzyme </li></ul><ul><li>Acts as catalysts </li></ul><ul><li>Regulate the metabolism </li></ul>
    36. 39. CLASSIFICATION <ul><li>FAT SOLUBLE: </li></ul><ul><ul><li>Vitamin A </li></ul></ul><ul><ul><li>Vitamin D </li></ul></ul><ul><ul><li>Vitamin E </li></ul></ul><ul><ul><li>Vitamin K </li></ul></ul><ul><li>WATER SOLUBLE: </li></ul><ul><ul><li>Vitamin B complex </li></ul></ul><ul><ul><li>Vitamin C </li></ul></ul>
    37. 41. VITAMIN A <ul><li>FUNCTIONS: </li></ul><ul><li>Formation of visual entity </li></ul><ul><li>Formation and maturation of epithelia </li></ul><ul><li>Promotion of bone remodeling </li></ul><ul><li>Oral health integrity </li></ul><ul><li>RDA: Infant- 350microgm </li></ul><ul><li>Children-400microgm </li></ul>
    38. 42. DEFICIENCY <ul><li>Night blindness </li></ul><ul><li>Xerophthalmia </li></ul><ul><li>Keratomalacia </li></ul><ul><li>Follicular hyperkeratosis </li></ul><ul><li>Goose Flesh </li></ul><ul><li>Ceasation of endochondral bone formation </li></ul>
    39. 43. <ul><li>ORAL MUCOUS MEMBRANE: epithelial metaplasia, hyperkeratinization </li></ul><ul><li>SALIVARY GLANDS: atrophy, reduction in salivary flow </li></ul><ul><li>TEETH: </li></ul><ul><li>pre-eruptive role for Vit A tooth development. </li></ul><ul><li>Post eruptive Vit A def - ↑caries scores </li></ul><ul><ul><li>Sally co workers </li></ul></ul><ul><li>MANAGEMENT: 30,000 IU orally/ day </li></ul>
    40. 44. VITAMIN D <ul><li>FUNCTION: </li></ul><ul><ul><li>Ca 2+ & PO 4 -2 absorption. </li></ul></ul><ul><ul><li>Development and calcification of bone </li></ul></ul><ul><li>RDA: 10 microgm </li></ul>
    41. 45. DEFICIENCY <ul><li>TEETH : </li></ul><ul><li>Enamel hypoplasia </li></ul><ul><li>Interglobular dentin </li></ul><ul><li>“ Calciotraumatic line” in dentin </li></ul><ul><li>ALVEOLAR BONE: </li></ul><ul><li>Loss of lamina dura </li></ul><ul><li>Reduced density of supporting bone </li></ul><ul><li>Loss of trabeculae </li></ul><ul><li>MANAGEMENT: 1000-5000 IU orally/ day </li></ul>
    42. 46.
    43. 49. VITAMIN E <ul><li>FUNCTIONS: </li></ul><ul><li>RDA: 4 IU </li></ul><ul><li>DEFICIENCY: </li></ul><ul><li>Anemia </li></ul><ul><li>Nervous degeneration. </li></ul><ul><li>MANAGEMENT: 300 IU/ day </li></ul>
    44. 50. VITAMIN K <ul><li>FUNCTION: </li></ul><ul><li>Catalyze synthesis of prothrombin by liver </li></ul><ul><li>Essential for production of VII, IX and X clotting factors </li></ul><ul><li>RDA : 70 microgm </li></ul><ul><li>DEFICIENCY : </li></ul><ul><li>Gingival bleeding </li></ul><ul><li>MANAGEMENT: </li></ul><ul><li>2-5 mg orally/ day </li></ul>GINGIVAL BLEEDING
    45. 51. VITAMIN B COMPLEX <ul><li>THIAMINE (VITAMIN B 1 ) </li></ul><ul><li>RIBOFLAVIN (VITAMIN B 2 ) </li></ul><ul><li>NIACIN (VITAMIN B 3 ) </li></ul><ul><li>PYRIDOXINE (VITAMIN B 6 ) </li></ul><ul><li>PANTOTHENIC ACID </li></ul><ul><li>BIOTIN </li></ul><ul><li>FOLIC ACID </li></ul><ul><li>COBALAMIN (VITAMIN B 12 ) </li></ul>
    46. 52. THIAMINE <ul><li>CARBOHYDRATE METABOLISM </li></ul><ul><li>RDA: 0.6 mg </li></ul><ul><li>DEFICIENCY: </li></ul><ul><ul><li>DRY BERI-BERI- </li></ul></ul><ul><ul><li>Peripheral neuritis </li></ul></ul><ul><ul><li>Ataxic gait </li></ul></ul><ul><ul><li>Foot and wrist drop </li></ul></ul><ul><ul><li>Anorexia </li></ul></ul><ul><ul><li>Weight loss </li></ul></ul><ul><ul><li>Weakness </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Drowsy </li></ul></ul>
    47. 53. <ul><li>WET BERI-BERI- </li></ul><ul><ul><li>Edema of legs </li></ul></ul><ul><ul><li>Cardiomegaly </li></ul></ul><ul><ul><li>Systolic murmurs </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Rapid and irregular Pulse </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Cardiac failure </li></ul></ul><ul><li>Oral manifestations: </li></ul><ul><li>Hyperesthesia of oral mucosa </li></ul><ul><li>Burning tongue </li></ul><ul><li>Loss of taste </li></ul><ul><li>Management: 5-10 mg/ day thiamine </li></ul>
    48. 54. RIBOFLAVIN <ul><li>CELLULAR RESP. </li></ul><ul><li>RDA: 0.7 mg </li></ul><ul><li>DEFICIENCY: </li></ul><ul><li>Dysphagia </li></ul><ul><li>Cheilosis </li></ul><ul><li>Angular stomatitis </li></ul><ul><li>Tongue appears purplish red or magenta, relatively clean often surface is deeply fissured. </li></ul><ul><li>If papilla are swollen- pebbled appearance of tongue </li></ul>
    49. 55. NIACIN <ul><li>Oxidative coenzymes </li></ul><ul><li>DEFICIENCY-PELLAGRA: </li></ul><ul><li>RDA : 8 mg </li></ul><ul><li>Dermatitis </li></ul><ul><li>Diarrhea </li></ul><ul><li>Dementia </li></ul><ul><li>If untreated- Death </li></ul>
    50. 56. <ul><li>Large beefy-red tongue </li></ul><ul><li>Fiery red and painful oral mucosa </li></ul><ul><li>Profuse salivation </li></ul><ul><li>Acute necrotizing ulcerative gingivits </li></ul><ul><li>Dysphagia </li></ul><ul><li>Management: </li></ul><ul><li>50-300 mg orally- 2weeks </li></ul>
    51. 57. PYRIDOXINE <ul><li>Fat and pr metabolism </li></ul><ul><li>RDA: 0.9 mg </li></ul><ul><li>DEFICIENCY: </li></ul><ul><ul><li>Microcytic hypochromic anemia </li></ul></ul><ul><ul><li>Growth retardation </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Peripheral neuropathy </li></ul></ul><ul><li>ORAL MANIFESTATION: </li></ul><ul><ul><li>Cheilosis </li></ul></ul><ul><ul><li>Glossitis </li></ul></ul><ul><ul><li>Stomatitis </li></ul></ul><ul><ul><li>Seborrheic dermatitis in nasolabial folds </li></ul></ul><ul><li>MANAGEMENT: 5mg IM </li></ul>SEBORRHEIC DERMATITIS
    52. 58. BIOTIN <ul><li>Co enzyme in the synthesis of DNA. </li></ul><ul><li>RDA: 100 microgm </li></ul><ul><li>DEFICIENCY: </li></ul><ul><ul><li>Lassitude </li></ul></ul><ul><ul><li>Anorexia </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Dermatitis </li></ul></ul><ul><ul><li>Glossitis </li></ul></ul><ul><li>MANAGEMENT: injection of 0.15-0.3 mg/ day </li></ul>
    53. 59. FOLIC ACID <ul><li>RBC, DNA </li></ul><ul><li>RDA: 40 microgm </li></ul><ul><li>DEFICIENCY: </li></ul><ul><ul><li>Macrocytic anemia. </li></ul></ul><ul><ul><li>Neural tube defects. </li></ul></ul><ul><li>ORAL MANIFESTATIONS: </li></ul><ul><ul><li>Glossitis </li></ul></ul><ul><ul><li>Burning sensation of oral mucosa </li></ul></ul><ul><ul><li>Angular cheilitis and gingivitis </li></ul></ul><ul><li>MANAGEMENT: </li></ul><ul><li>30 mcg – infants </li></ul>
    54. 60. COBALAMIN <ul><li>RDA: 0.2- 1 microgm </li></ul><ul><li>DEFICIENCY: PERNICIOUS ANEMIA </li></ul><ul><li>“ combined system disease”- macrocytic anemia and nervous disorders </li></ul><ul><li>ORAL MANIFESTATIONS: </li></ul><ul><ul><li>Glossitis </li></ul></ul><ul><ul><li>Glossodynia </li></ul></ul><ul><ul><li>Glossopyrosis </li></ul></ul><ul><ul><li>Slick denuded tongue </li></ul></ul><ul><li>MANAGEMENT: 1-3 microgm/ day </li></ul>
    55. 61. VITAMIN C <ul><li>RDA: 45-50 mg </li></ul><ul><li>DEFICIENCY - SCURVY </li></ul><ul><li>Irritability </li></ul><ul><li>Swelling of extremities at the end of the bone </li></ul><ul><li>Scorbutic rosary </li></ul><ul><li>Pain on movement of the limbs </li></ul>SCORBUTIC ROSARY
    56. 62. <ul><ul><li>Hemorrhagic tendencies </li></ul></ul><ul><ul><li>Petechial hemorrhages around hair follicles </li></ul></ul><ul><ul><li>Increased susceptibility to infection </li></ul></ul><ul><ul><li>Delayed wound healing </li></ul></ul>
    57. 63. <ul><li>Red swollen interdental and </li></ul><ul><li>marginal gingiva </li></ul><ul><li>Gingival friability </li></ul><ul><li>Increased tooth mobility </li></ul><ul><li>Sore burning mouth </li></ul><ul><li>Soft tissue ulceration </li></ul><ul><li>Increased risk of candidiasis </li></ul><ul><li>Malformed teeth (inadequate dentin) </li></ul><ul><li>MANAGEMENT: 50-100 mg four times/ day </li></ul>
    58. 64.
    59. 65.
    60. 66.
    61. 67.
    62. 68. <ul><li>Shelling & Anderson –in series of richatic children 43% of teeth – enamel hypoplasia (pitting variety). </li></ul><ul><li>Involve those teeth that form within the 1 st yr of birth. </li></ul><ul><ul><li>Central ,lateral incisors, 1 st molars. </li></ul></ul><ul><li>Premolars, 2 nd , 3 rd molars – seldom affected . </li></ul>ENAMEL
    63. 69. DENTINE <ul><li>Vit A def : </li></ul><ul><ul><li>Tubular arrangement is disturbed </li></ul></ul><ul><ul><li>Contains cellular & vascular inclusions. </li></ul></ul><ul><li>Vit C def : </li></ul><ul><ul><li>Atrophy & disorganization of the odontoblasts. </li></ul></ul><ul><ul><li>Dentine is irregularly laid down with irregularly arranged tubules. </li></ul></ul><ul><ul><li>Dentin formation ceases, Predentin becomes hypercalcified </li></ul></ul>
    64. 70. MINERALS <ul><li>FUNCTIONS: </li></ul><ul><ul><li>Structural components for the body </li></ul></ul><ul><ul><li>Nerve and muscle function </li></ul></ul><ul><ul><li>Blood clotting </li></ul></ul><ul><ul><li>Tissue growth and repair </li></ul></ul><ul><ul><li>Acid- base balance of body fluids </li></ul></ul><ul><ul><li>Cofactors for enzymes in chemical reaction within the body </li></ul></ul>
    65. 71. <ul><li>CLASSIFICATION: </li></ul><ul><ul><li>Major minerals: 100mg/ day. </li></ul></ul><ul><ul><li>Trace minerals: lesser amounts </li></ul></ul><ul><li>Major minerals: </li></ul><ul><li>1.Ca 4. K 7.S </li></ul><ul><li>2.Mg 5. Na </li></ul><ul><li>3.P 6. Cl </li></ul><ul><li>Trace elements: </li></ul><ul><li>1.F 5.Ch 9.Mn </li></ul><ul><li>2.Fe 6. Cu </li></ul><ul><li>3.Zn 7. I </li></ul><ul><li>4. Se 8. Mb </li></ul>
    66. 75. Calcium <ul><li>Body content, distribution : </li></ul><ul><li>Avg sized man – 1kg of Ca in his body. </li></ul><ul><li>99% of body – bone </li></ul><ul><li>Rest – cells, ECF. </li></ul><ul><li>Functions: </li></ul><ul><li>2 major functions. </li></ul><ul><li>Functions due to Ca in bone & ECF. </li></ul><ul><li>Functions due to presence of Ca++ in the cytosol. </li></ul>
    67. 76. <ul><li>Functions due to the Ca in the bone & ECF: </li></ul><ul><li>Gives strength to the bone </li></ul><ul><li>Takes part in the homeostasis </li></ul><ul><li>Required in regulating neuromuscular activity </li></ul><ul><li>Required in regulations of hormones-PTH, thyroid hormones, </li></ul><ul><li>Functions within the cell wall: </li></ul><ul><li>, </li></ul><ul><li>For Muscular contraction- cardiac muscle contraction </li></ul><ul><li>skeletal muscle contraction </li></ul><ul><li>Act as secondary messenger </li></ul><ul><li>Responsible for release of Ach as neurotransmitter </li></ul>
    68. 77. <ul><li>SOURCES: </li></ul><ul><li>Milk & milk products </li></ul><ul><li>Eggs </li></ul><ul><li>ABSORPTION: </li></ul><ul><li>principally – upper part jejunum </li></ul><ul><li>Other parts of the intestine as well. </li></ul>
    69. 78. <ul><li>DEFICIENCY: </li></ul><ul><li>Incomplete mineralization of teeth </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Excessive bone resorption and bone fragility </li></ul><ul><li>Increased tendency to haemorrhage </li></ul><ul><li>Increased tooth mobility </li></ul><ul><li>Premature tooth loss </li></ul><ul><li>“ PEAK BONE MASS” </li></ul>TEETH HYPOPLASIA
    70. 79. FLUORIDE <ul><li>FUNCTIONS: </li></ul><ul><li>Incorporated into tooth structure </li></ul><ul><li>Aids in resistance to caries </li></ul><ul><li>Excess: </li></ul><ul><li>Disturbed amelogenesis </li></ul><ul><li>Mottled enamel </li></ul>
    71. 80. zinc <ul><li>RDA:10-12mg. </li></ul><ul><li>FUNCTIONS: </li></ul><ul><ul><li>Integral part of many enzymes. </li></ul></ul><ul><ul><li>Wound healing. </li></ul></ul><ul><ul><li>Growth of all tissues. </li></ul></ul><ul><ul><li>RNA & DNA synthesis. </li></ul></ul><ul><li>DEFFICENCY: </li></ul><ul><ul><li>Delayed wound healing. </li></ul></ul><ul><ul><li>Retarded growth and sexual development. </li></ul></ul><ul><ul><li>Loss of taste. </li></ul></ul><ul><li>SOURCES: </li></ul><ul><ul><li>Foods rich in protein </li></ul></ul><ul><li>C/A: </li></ul><ul><ul><li>Zinc peroxide powder. </li></ul></ul><ul><ul><li>Zinc sulphate. </li></ul></ul>
    72. 81. TRACE ELEMENTS AND CARIES EFFECT MINERAL CARIOSTATIC F, P MILDLY CARIOSTATIC Mo, V, Cu, Sr, B, Li, Au, Fe DOUBTFUL Co, Mn, Sn, Zn, Br, I CARIES INERT Ba, Al, Ni, Pd, Ti CARIES PROMOTING Se, Mg, Cd, Pt, Pb, Si
    73. 82. WATER <ul><li>Vital nutrient , </li></ul><ul><li>Varies from-50-70%. </li></ul><ul><li>2 main compartments- Extracellular , intracellular. </li></ul><ul><li>FUNCTIONS: </li></ul><ul><li>Electrolyte balance. </li></ul><ul><li>Metabolic reaction. </li></ul><ul><li>Solvent. </li></ul><ul><li>Vehicle to transport. </li></ul><ul><li>temp regulation. </li></ul><ul><li>Dissolves. </li></ul><ul><li>Lubricant in digestion </li></ul>
    74. 83. <ul><li>WATER REQURIMENT: </li></ul><ul><li>Based on body size </li></ul><ul><li>Determined by- per kg body wt. </li></ul>Age in yrs Water (ml/kg body wt Infants Birth- 1yr 100-120 Children 1-10 60-80 Adolescents 11-18 41-55 Adults 19-51 20-30
    75. 85. EFFECTS OF NUTRITION ON IMMUNE RESPONSES <ul><li>Nutrition - Critical determinant of immune responses </li></ul><ul><li>DECREASE: </li></ul><ul><ul><li>Salivary antimicrobial property. </li></ul></ul><ul><ul><li>Immune cell differentiation. </li></ul></ul><ul><ul><li>Response to antigen. </li></ul></ul><ul><ul><li>Antibody production. </li></ul></ul><ul><ul><li>Lymphocyte production. </li></ul></ul><ul><ul><li>Phagocytic function of neutrophils. </li></ul></ul><ul><li>INCREASE: </li></ul><ul><ul><li>Bacterial cell adhesion. </li></ul></ul>
    76. 86. HOW ? do u keep yourself healthy
    77. 87. <ul><li>FOLLOWING THE FOOD GUIDE PYRAMID. </li></ul><ul><li>HEALTHY EATING HABITS. </li></ul><ul><li>GOOD FOOD CHOICES. </li></ul>
    78. 88. FOOD GUIDE PYRAMID
    79. 90. DIETARY GUIDELINES BY AGE AGE TEXTURE NUTRIENTS FOODS MEAL PATTERN 0-6mts liquid Energy dense Human milk Infant formula On demand 6mts-1y mashed food - Home prepared food Initiate structured meals 1-2y Chopped table food Sources of iron Toddlers formula - 2-5y Avoid foods chocking Reduce fat intake Food guide pyramid. - 6-12y 30% energy from fat - - >12y - - -
    80. 91. Who ? Is at Nutritional risk
    81. 92. NUTRITIONAL RISK ASSESSMENT <ul><li>Pts complaints &medical & social histories. </li></ul><ul><li>Dietary history & evaluations </li></ul><ul><li>Physical examination- anthropometric measurements </li></ul><ul><li>Pertinent lab test. </li></ul>
    82. 93. <ul><li>COMPLAINTS: </li></ul><ul><ul><li>general weakness </li></ul></ul><ul><ul><li>Chronic fatigue </li></ul></ul><ul><ul><li>Loss of appetite </li></ul></ul><ul><ul><li>Painful bleeding gums </li></ul></ul><ul><ul><li>Loss of wt </li></ul></ul><ul><ul><li>Sore lips, OMM, tongue </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Loss of ability to concentrate. </li></ul></ul><ul><ul><li>Loss of manual dexterity </li></ul></ul>
    83. 94. <ul><li>Medical and social histories: </li></ul><ul><ul><li>Chronic debilitating diseases </li></ul></ul><ul><ul><li>Digestive disturbances </li></ul></ul><ul><ul><li>Ulcerative colitis </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><li>Emotional problems: </li></ul><ul><ul><li>Excessive wt loss – anorexia nervosa </li></ul></ul><ul><ul><li>Food fads </li></ul></ul><ul><ul><li>medically unsupervised quick wt reduction diets </li></ul></ul>
    84. 95. <ul><li>DIETARY HISTORY & EVALUTION: </li></ul><ul><li>24 hr recall </li></ul><ul><li>3day record </li></ul><ul><li>5 day record </li></ul><ul><li>7 day record </li></ul><ul><li>Adequacy of food = Nutrients consumed (nutritive values of food) </li></ul><ul><li>RDA </li></ul>
    85. 96. PHYSICAL SIGNS OF MALNUTRITION
    86. 98. Who ? Needs special nutritional care
    87. 99. <ul><li>FEVER. </li></ul><ul><li>SURGERY. </li></ul><ul><li>TMJ. </li></ul><ul><li>NEW APPLIANCE WEARERS. </li></ul><ul><li>ORTHODONTIC PATIENTS. </li></ul><ul><li>DIABETIC. </li></ul><ul><li>CL & CP </li></ul>
    88. 100. <ul><li>Pandya and Boorman: </li></ul><ul><ul><li>32% U CL&P. </li></ul></ul><ul><ul><li>38% B CL&p. </li></ul></ul><ul><ul><li>49% CP. </li></ul></ul><ul><li>Difficulties: </li></ul><ul><li>Modified feeding methods: </li></ul><ul><ul><li>Obturators. </li></ul></ul><ul><ul><li>Slow feeding. </li></ul></ul><ul><ul><li>Specialized bottles and nipples. </li></ul></ul>
    89. 102. FOOD ASSISTANT PROGRAMS <ul><li>It was developed for the individuals at risk for poor nutritional intakes </li></ul><ul><li>Family food assistance program </li></ul><ul><ul><li>Food stamp program </li></ul></ul><ul><li>Child nutrition programs-funded by govt: local, state, federal level </li></ul><ul><ul><li>School breakfasts </li></ul></ul><ul><ul><li>School lunches special milk program </li></ul></ul><ul><ul><li>Summer food program </li></ul></ul><ul><ul><li>Mid-day meal program </li></ul></ul><ul><ul><li>Urban special nutrition program </li></ul></ul><ul><ul><li>Integrated child development services scheme. </li></ul></ul>
    90. 103. WHAT ? are eating disorders
    91. 104. DISORDRED EATING <ul><li>CHILDREN: </li></ul><ul><ul><li>RUMINATION. </li></ul></ul><ul><ul><li>PSYCHOLOGICAL DWARFISIM. </li></ul></ul><ul><ul><li>PICA. </li></ul></ul><ul><ul><li>CHILDHOOD OBESITY. </li></ul></ul><ul><li>ADOLESCENTS: </li></ul><ul><ul><li>ANOREXIA NERVOSA </li></ul></ul><ul><ul><li>BULIMIA NERVOSA. </li></ul></ul><ul><ul><li>ORTHOREXIA NERVOSA. </li></ul></ul><ul><ul><li>ATHELETICA NERVOSA. </li></ul></ul>
    92. 105. RUMINATION <ul><ul><li>3-12 months, </li></ul></ul><ul><ul><li>Voluntary regurgitation, chewing, & reswallowing of stomach contents. </li></ul></ul><ul><ul><li>Self stimulatory behavior </li></ul></ul><ul><ul><li>Psychosocial issues. </li></ul></ul><ul><ul><li>Mental retardation </li></ul></ul><ul><ul><li>Risk of enamel erosion. </li></ul></ul>
    93. 106. PSYCHOSOCIAL DWARFISM <ul><li>18-48 months </li></ul><ul><li>No expected growth pattern . </li></ul><ul><li>Deceleration of linear growth. </li></ul><ul><li>Characteristic behavior patterns </li></ul><ul><ul><li>Bizarre eating patterns. </li></ul></ul><ul><ul><li>Sleep habits. </li></ul></ul><ul><li>Severe food insecurity . </li></ul><ul><li>Eating garbage / pet food. </li></ul><ul><li>Severely dysfunctional “care giver- child interaction”. </li></ul>
    94. 107. PICA <ul><ul><li>Pathologic craving for substance not commonly regarded as food </li></ul></ul><ul><ul><li>Classic ex; starch, ice paint chips, dirt, paper, </li></ul></ul><ul><ul><li>Risk of direct toxicity- ↑ </li></ul></ul><ul><ul><li>Pb poisoning </li></ul></ul>
    95. 108. CHILDHOOD OBESITY <ul><li>Risk for overweight: 85 th % to 95 th % </li></ul><ul><li>Over weight: >95 th % </li></ul><ul><li>CAUSES: </li></ul><ul><ul><li>T. V & Video games. </li></ul></ul><ul><ul><li>Emphasis on education. </li></ul></ul><ul><ul><li>Advertisements. </li></ul></ul><ul><ul><li>Pampering parents. </li></ul></ul><ul><li>MANAGEMENT: </li></ul><ul><ul><li>Diet counseling. </li></ul></ul><ul><ul><li>Changes in dietary habits. </li></ul></ul><ul><ul><li>Referral. </li></ul></ul>
    96. 109. ANOREXIA NERVOSA <ul><li>0.5% - 1% teens are effected. </li></ul><ul><li>FOUR DIAGNOSTIC CRITERIA: </li></ul><ul><ul><li>Refusal to maintain body weight =/> 85 th %. </li></ul></ul><ul><ul><li>Intense fear of gaining weight. </li></ul></ul><ul><ul><li>Distorted view of ones body. </li></ul></ul><ul><ul><li>Absence of at least 3 consecutive menstrual cycles. </li></ul></ul>
    97. 110. PHYSICAL SIGNS MEDICAL COMPLICATIONS ASSOCIATED
    98. 111. BULIMIA NERVOSA <ul><li>It literally means &quot;ox hunger.“ </li></ul><ul><li>1-3 percent. </li></ul><ul><li>DIAGNOSTIC CRITERIA: </li></ul><ul><ul><li>Eating large amounts of food in less than 2hrs. </li></ul></ul><ul><ul><li>Lack of control over eating. </li></ul></ul><ul><ul><li>Compensatory behavior to prevent weight gain. </li></ul></ul><ul><ul><li>Occurs twice in a week for 3 consecutive months. </li></ul></ul><ul><ul><li>Concern about body size. </li></ul></ul>
    99. 113. <ul><li>PHYSICAL SIGNS : </li></ul><ul><ul><li>headaches </li></ul></ul><ul><ul><li>red eyes </li></ul></ul><ul><ul><li>darkness under the eyes </li></ul></ul><ul><ul><li>damaged cuticles </li></ul></ul><ul><ul><li>scarred and/or calloused knuckles </li></ul></ul><ul><ul><li>weekly fluctuations in weight of five to ten pounds </li></ul></ul><ul><li>MEDICAL COMPLICATIONS: </li></ul><ul><ul><li>dehydration </li></ul></ul><ul><ul><li>potassium imbalance </li></ul></ul><ul><ul><li>gastric distension </li></ul></ul><ul><ul><li>gastric ruptures </li></ul></ul><ul><ul><li>gastrointestinal bleeding </li></ul></ul><ul><ul><li>cardiac arrhythmias </li></ul></ul><ul><ul><li>constipation </li></ul></ul><ul><ul><li>As with anorexia, the ultimate medical complication is death. </li></ul></ul>
    100. 114. ORAL MANIFESTATIONS <ul><li>PERMIOLYSIS: </li></ul><ul><ul><li>pH of vomitus 2.9-5.5. </li></ul></ul><ul><ul><li>Detected in 6mts after onset. </li></ul></ul><ul><ul><li>Translucent enamel </li></ul></ul><ul><ul><li>Raised margins of amalgam restorations. </li></ul></ul>
    101. 115. <ul><li>DENTAL CARIES. </li></ul><ul><li>DENTINE HYPERSENSITIVITY. </li></ul><ul><li>XEROSTOMIA. </li></ul><ul><li>SALIVARY GLAND HYPERTROPHY. </li></ul><ul><li>SOFT TISSUE LESIONS. </li></ul>
    102. 116. <ul><li>PREVENTIVE TREATMENT: </li></ul><ul><ul><li>Fluoride rinse. </li></ul></ul><ul><ul><li>Provide custom tray. </li></ul></ul><ul><ul><li>Alkaline mouth rinse (NaHCO 3 ). </li></ul></ul><ul><ul><li>Soft tooth brush. </li></ul></ul><ul><ul><li>Cheese, nuts, whole fruits and vegetables. </li></ul></ul><ul><ul><li>Stimulate saliva – sugar free chewing gums. </li></ul></ul><ul><ul><li>Place temporary restoration. </li></ul></ul>
    103. 117. <ul><li>Anorexia and bulimia both arise from underlying psychological feelings that can be caused by: </li></ul><ul><ul><li>Depression. </li></ul></ul><ul><ul><li>Guilt. </li></ul></ul><ul><ul><li>Low self-esteem. </li></ul></ul><ul><ul><li>Death of a family member, unhappy family. </li></ul></ul><ul><ul><li>Societal pressure. </li></ul></ul><ul><ul><li>Feelings of isolation </li></ul></ul><ul><ul><li>Physical or sexual abuse </li></ul></ul>
    104. 118. <ul><li>MANAGEMENT: </li></ul><ul><li>Treatment – 2 fold : </li></ul><ul><ul><li>Management of underlying social situation / psychological disorder </li></ul></ul><ul><ul><li>Environmental control of the feeding situation </li></ul></ul><ul><li>INTERDISCIPLINARY APPROACH: </li></ul><ul><li>Physician </li></ul><ul><li>Psychologist </li></ul><ul><li>Nurse </li></ul><ul><li>Dietician </li></ul>
    105. 119. REFERENCES <ul><li>Principles & practice of medicine……………………………………………..…..Davidson. </li></ul><ul><li>A text book of oral pathology……………………………………………………………Shafer. </li></ul><ul><li>Nutrition and preventive dentistry……………………………………………………..Nizel. </li></ul><ul><li>Nutrition, diet, and oral health………………………….… Andrew J. Rugg- Gunn. </li></ul><ul><li>Cariology……………………………………………………………………………..…Ernest Newbrun. </li></ul><ul><li>Dentistry for the child and adolescent……………………………………..McDonald. </li></ul><ul><li>Scientific foundation………………………………………………………………………. Stewart. </li></ul><ul><li>Nutrition and oral health……………………………………………………….. DCNA- 2003. </li></ul><ul><li>Journal of dentistry for children sep-oct 1986 53(5). </li></ul><ul><li>Journal of contemporary dental practice 2001 May 15; 2(2). </li></ul>
    106. 120. THANK ‘U’

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